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AF ablation Atrial fibrillation General Cardiology General Medicine

AF Ablation Update 2019

Most years I write an update on any big developments in AF ablation. This year’s version will be a short one. I have little new to report. But it’s worth reviewing some basic issues. We still do not know the cause of atrial fibrillation (AF). That makes it hard to fix with ablation. Knowledge Deficits: […]

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AF ablation Atrial fibrillation

Musings on the CABANA trial — AF ablation vs Drugs

Last week at the Heart Rhythm Society meeting in Boston, Dr. Douglas Packer from the Mayo Clinic presented results of The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. I cannot remember a more consequential HRS (Heart Rhythm Society) meeting. Before and after the presentation, CABANA talk dominated conversations amongst colleagues. I wrote […]

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AF ablation Atrial fibrillation

Thoughts on CABANA — The biggest study in AF ablation in years

(The CABANA trial is slated for release in two days at the 2018 HRS Meeting. Here is a preview.) Technology has made modern life easier. This is good for lots of things, but not for avoiding atrial fibrillation (AF). As people in Western society grow older, heavier, less physically active, more distracted, and perhaps more […]

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AF ablation Doctoring General Ablation General Cardiology

AF Ablation is Overused in the US

A colleague recently asked me if atrial fibrillation (AF) ablation was overused. Yes it is. AF ablation has become the wild west of electrophysiology. There is essentially no scrutiny of this invasive, expensive and risky procedure. I also include here the add-on “maze-like” procedures done during heart surgery for other conditions. I believe they too […]

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AF ablation Atrial fibrillation Doctoring General Medicine Health Care

Should AF ablation require approval from a heart team?

A patient presents with atrial fibrillation (AF) and a rapid rate. He doesn’t know he is in AF; all he knows is that he is short of breath and weak. The doctors do the normal stuff. He is treated with drugs to slow the rate and undergoes cardioversion. During the hospital stay, he receives a […]

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AF ablation Atrial fibrillation Doctoring General Cardiology Health Care Knowledge

Is AF ablation a big placebo?

Turkish authors boldly raised this question in a recent editorial. They likened AF ablation to renal denervation, a procedure in which RF ablation in the kidneys was felt to reduce BP. Many studies showed kidney ablation markedly lowered BP. Then a trial was done with a sham control (people got part of the procedure but […]

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AF ablation Atrial fibrillation Doctoring

Big news in AF ablation from HRS 2016

I have recently returned from the 2016 Heart Rhythm Society Sessions in San Francisco. I wrote three articles for Medscape. I also did two podcasts from HRS. I will link these below. You need to sign up for Medscape (free) to read the essays and listen to the podcast. In the first article, I discussed […]

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AF ablation Athletic heart General Ablation General Cardiology

AF ablation still has a role

I have been seeing a new trend in the AF clinic. I never thought this would happen, but I’d estimate that at least once daily, often multiple times daily, a patient says they have read this blog before the visit. That is nice. Many of these patients, some who have traveled across the country, or […]

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AF ablation Atrial fibrillation

AF Ablation Update – 2016

I do AF ablation. But, similar to my 2015 update, I continue to do fewer of these procedures. What is new in 2016 is more confidence that this is the right approach. My technique for ablating AF has not changed. I do pulmonary vein isolation (PVI) with point-to-point RF. Each burn takes 10-30 seconds, and […]

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AF ablation Atrial fibrillation

In AF ablation, ask tough questions about left atrial appendage isolation

A study presented recently at the 2015 European Society of Cardiology meeting promoted electrical isolation of the left atrial appendage as a useful strategy for the ablation of long-standing persistent AF. The study came from an influential research group. ESC increased the influence of this trial by making it a “Hot-Line” session presentation. The BELIEF […]

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AF ablation Atrial fibrillation Doctoring Exercise General Cardiology

A cautionary note on AF ablation in 2015

It’s time to write an update on AF ablation. Things have changed. The major change is that I am doing many fewer ablations for AF. The reason is we have a better understanding of the disease, or should I say, condition? In the last 2-3 years, good science has changed the way specialists see AF. […]